A case of peripheral T-cell lymphoma in which therapy-related myelodysplastic syndrome developed and a second autologous transplantation was performed

Abstract

We report a case of therapy-related myelodysplastic syndrome (MDS), which developed 9 years after autologous peripheral blood stem cell transplantation (PBSCT) for peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). A 65-year-old male was diagnosed with PTCL-NOS. After 6 cycles of the CHOP (cyclophosphamide [CPA], doxorubicin, vincristine, and prednisone) regimen, he achieved a first complete response (CR). He relapsed 33 months later and received salvage chemotherapy, which consisted of the CHASE regimen (CPA, high-dose cytarabine, dexamethasone, and etoposide). During the recovery phase of the first cycle of CHASE, his peripheral blood stem cells (PBSCs) were harvested and frozen in 2 bags. After 2 courses of CHASE, he underwent autologous PBSCT, which involved the use of the LEED preconditioning regimen (melphalan, CPA, etoposide, and dexamethasone) and one of the frozen bags. This resulted in a second CR. At 39 months after PBSCT, he relapsed with a tumor in his right arm. After it was resected, he received eight cycles of brentuximab vedotin and 45 Gy of involved-field irradiation concurrently and achieved a third CR. Nine years after autologous PBSCT, he was diagnosed with MDS with excess blasts 2 (MDS-EB-2). His disease progressed to acute myeloid leukemia after 2 courses of azacitidine therapy. He successfully underwent a second autologous PBSCT involving the busulfan and melphalan preconditioning regimen and the other frozen bag, which had been stored for 9 years. He has been in complete cytogenetic remission for 1 year since the second autologous PBSCT.

Keywords: autologous peripheral blood stem cell transplantation; peripheral T-cell lymphoma, not otherwise specified; therapy-related myelodysplastic syndrome.

Fig. 1

(A) An axillary lymph node biopsy showed the diffuse proliferation of atypical large lymphoid cells with eosinophilic cytoplasm. (B) CD3 staining. (C) CD4 staining. (D) CD8 staining. (E) CD30 staining.

Fig. 2

A chart of the clinical course. PTCL, peripheral T-cell lymphoma; t-MDS, therapy-related myelodysplastic syndrome; CR, complete response; CR1, first CR; CR2, second CR; CR3, third CR; REL1, first relapse; REL2, second relapse; PBSCH, peripheral blood stem cell harvest; PBSCT, peripheral blood stem cell transplantation; CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone; CHASE, cyclophosphamide, high-dose cytarabine, dexamethasone, and etoposide; LEED, melphalan, cyclophosphamide, etoposide, dexamethasone; BV, brentuximab vedotin; IF-RT, involved-field radiotherapy; AZA, azacitidine; BU+MEL, busulfan and melphalan.

Fig. 3

A BM smear obtained at the diagnosis of MDS revealed an excess of blasts (arrow in A), degranulation of neutrophils, and micromegakaryoIcyte (arrowhead in B).